[残余和/或复发性胆总管结石所致梗阻性黄疸：内镜治疗与手术治疗]

[Obstructive jaundice caused by residual and/or recurrent choledochal lithiasis: endoscopic and surgical treatment].

作者信息

Fornaro R, Carissimi T, Belcastro E, Cambiaso C, Estienne G, Boidi M, Taviani M, Ferraris R

机构信息

Cattedra di Semeiotica Chirurgica R, Università degli Studi di Genova.

出版信息

Chir Ital. 1993 Feb-Dec;45(1-6):45-52.

PMID:7923499

Abstract

Results of surgical and endoscopic treatment in 79 patients (58 females and 21 males, age 40-89, mean 62), affected with jaundice, due to secondary choledochal lithiasis, are reported. Thirty-four patients (43%) underwent surgical operation: choledochotomy and T-tube 12, choledocho-jejunostomy 4, choledochoduodenostomy 3, papillosphincteroplasty 15. In 45 patients (57%) EST has been performed. Comparison of results has been obtained after 30 days and after 3-105 months (mean 49). Optimal results have been achieved in 94.9% of patients: 100% after surgery and 94.1% after EST. Morbidity and mortality outcomes in patients who underwent EST (11.1% and 0% after 30 days respectively, 8.1% and 8.1% after several months) are better compared to those ones after surgical treatment (17.6% and 5.8% after 30 days, 20% and 16% after several months). We conclude that EST is nowadays the therapy of choice in patients with jaundice due to choledochal lithiasis, either relapsing or residual.

摘要

报告了79例（58例女性，21例男性，年龄40 - 89岁，平均62岁）因继发性胆总管结石而出现黄疸患者的手术及内镜治疗结果。34例（43%）患者接受了手术：胆总管切开术及T管引流12例，胆总管空肠吻合术4例，胆总管十二指肠吻合术3例，乳头括约肌成形术15例。45例（57%）患者进行了内镜下括约肌切开术（EST）。在术后30天以及3 - 105个月（平均49个月）后对结果进行了比较。94.9%的患者取得了最佳效果：手术组为100%，EST组为94.1%。与手术治疗患者相比，接受EST治疗的患者的发病率和死亡率结果更好（术后30天分别为11.1%和0%，数月后为8.1%和8.1%，而手术治疗患者术后30天为17.6%和5.8%，数月后为20%和16%）。我们得出结论，如今EST是因胆总管结石导致黄疸的患者（无论是复发性还是残留性）的首选治疗方法。